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      • Smoking Prevalence
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        • Removal and Examination of 12 or More Lymph Nodes in Colon Resections
        • Resection Rates for Stage II or III Rectal Cancer, Stage III Colon Cancer and Stage II or IIIA Non-Small Cell Lung Cancer Patients
        • The Use of Breast-Conserving Surgery versus Mastectomies for Breast Cancer Resections
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        • Post-Operative Chemotherapy for Stage III Colon Cancer Patients
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      • Adult Clinical Trial Participation
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    • 7. Appropriateness
      • Breast Cancer Screening Outside of Guidelines
      • Breast Cancer Mastectomies Done as Day Surgery
      • Intensive care use in the last two weeks of life
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  • Disease Site
    • Breast
      • Breast Cancer Screening
      • Screening in Underserved Populations
      • Breast Cancer Diagnosis Wait Time
      • Capture of Stage
      • Stage Distribution
      • Surgery
        • Breast Cancer Resections That Are Mastectomies
        • The Use of Breast-Conserving Surgery versus Mastectomies for Breast Cancer Resections
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        • Post-Operative Radiation Therapy for Stage I or II Breast Cancer Patients
      • Place of Death
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      • Breast Cancer Screening Outside Recommended Guidelines
      • Incidence and mortality rates
      • Five-year net survival by income quintile for several cancers in Canada
    • Colorectal
      • Colorectal Cancer Screening
      • Screening in Underserved Populations
      • Colorectal Cancer Diagnosis Wait Time
      • Capture of Stage
      • Stage Distribution
      • Surgery
        • Removal and Examination of 12 or More Lymph Nodes in Colon Resections
        • Resection Rates for Stage II or III Rectal Cancer, Stage III Colon Cancer and Stage II or IIIA Non-Small Cell Lung Cancer Patients
      • Radiation Therapy
        • Pre-operative Radiation Therapy for Patients with Stage II or III Rectal Cancer
      • Post-Operative Chemotherapy for Stage III Colon Cancer Patients
      • Place of Death
      • Adult Clinical Trial Participation
      • Cancer Research Investment
      • Incidence and mortality rates
      • Five-year net survival by income quintile for several cancers in Canada
    • Lung
      • Capture of Stage
      • Stage Distribution
      • Resection Rates for Stage II or IIIA Non-Small Cell Lung Cancer Patients
      • Post-Operative Chemotherapy for Stage II or IIIA Non-Small Cell Lung Cancer Patients
      • Place of Death
      • Adult Clinical Trial Participation
      • Cancer Research Investment
      • Incidence and mortality rates
      • Five-year net survival by income quintile for several cancers in Canada
    • Prostate
      • PSA Testing
      • Prostate Stage-Specific Incidence
      • Prostate Risk Profile
      • Capture of Stage
      • Stage Distribution
      • Prostate Wait Times for Surgery
      • Prostate Wait Times for Radiation Therapy
      • Radical Prostatectomy: Open versus Laparoscopic Surgery
      • Prostate Patterns of Care: Radiation and Surgical Treatment
      • Prostate Patient Satisfaction with Care
      • Prostate Place of Death
      • Prostate Access to Palliative Radiation
      • Prostate Clinical Trials Participation
      • Adult Clinical Trial Participation
      • Prostate Cancer Research Investment
      • Cancer Research Investment
      • Incidence & Mortality Rates
      • Five-year net survival by income quintile for several cancers in Canada
    • Cervical
      • Human Papillomavirus (HPV) Vaccination
      • Cervical Cancer Screening
      • Screening in Underserved Populations
    • Pancreas
      • Incidence and mortality rates
    • Ovarian
      • Stage Distribution
      • Incidence and mortality rates
  • Province & Territory
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  • The Use of Breast-Conserving Surgery versus Mastectomies for Breast Cancer Resections

The Use of Breast-Conserving Surgery versus Mastectomies for Breast Cancer Resections

  • Charts and Tables

    Charts and Tables

    Figure 4.5

    Percentage of breast cancer resections that were breast-conserving surgeries, by province/‌territory — 2009/10 to 2013/14 fiscal years combined

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      Data Table

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    Breast-conserving surgery data shown only include women who underwent breast-conserving surgery as a final procedure
    Territories include Yukon, Northwest Territories and Nunavut.
    Data source: Canadian Institute for Health Information, Hospital Morbidity Database, National Ambulatory Care Reporting System; Alberta Health and Wellness, Alberta Ambulatory Care Reporting System.

    Data Table

    Province/TerritoriesNumber of women who underwent breast-conserving surgeries (final)Percent (%)Lower bound of 95% confidence intervalUpper bound of 95% confidence interval
    BC7,36354.853.955.6
    AB4,49948.347.349.3
    SK1,05137.635.839.4
    MB2,17063.862.165.4
    ON24,44063.963.464.4
    QC20,09375.174.675.6
    NB1,33356.754.758.7
    NS1,49250.148.351.9
    PE24051.446.856
    NL49830.828.633.1
    Territories7235.328.742.3

    + Expand Table

    Breast-conserving surgery data shown only include women who underwent breast-conserving surgery as a final procedure
    Territories include Yukon, Northwest Territories and Nunavut.
    Data source: Canadian Institute for Health Information, Hospital Morbidity Database, National Ambulatory Care Reporting System; Alberta Health and Wellness, Alberta Ambulatory Care Reporting System.

    Figure 4.6

    Percentage of breast cancer resections that were breast-conserving surgeries, by province/‌territory — 2008/09–2010/11 vs. 2011/12–2013/14 fiscal years combined

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      Data Table

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    Breast-conserving surgery data shown only include women who underwent breast-conserving surgery as a final procedure
    Territories include Yukon, Northwest Territories and Nunavut.
    Data source: Canadian Institute for Health Information, Hospital Morbidity Database, National Ambulatory Care Reporting System; Alberta Health and Wellness, Alberta Ambulatory Care Reporting System.

    Data Table

    Province/TerritoriesFiscal year periodNumber of women who underwent breast-conserving surgeries (final)Percent (%)Lower bound of 95% confidence intervalUpper bound of 95% confidence interval
    BC2008/09–2010/114,25654.753.655.9
    BC2011/12–2013/144,47554.953.856.0
    AB2008/09–2010/112,29344.142.745.4
    AB2011/12–2013/142,92451.149.852.4
    SK2008/09–2010/1163037.735.440.1
    SK2011/12–2013/1464237.335.039.6
    MB2008/09–2010/111,29265.163.067.2
    MB2011/12–2013/141,30963.161.065.2
    ON2008/09–2010/1113,93963.362.663.9
    ON2011/12–2013/1414,91963.963.364.6
    QC2008/09–2010/1111,30774.373.675.0
    QC2011/12–2013/1412,50575.574.876.1
    NB2008/09–2010/1175453.751.156.4
    NB2011/12–2013/1480758.055.360.6
    NS2008/09–2010/1184345.943.648.3
    NS2011/12–2013/1492452.349.954.6
    PE2008/09–2010/1113750.944.857.1
    PE2011/12–2013/1412946.640.652.6
    NL2008/09–2010/1128731.228.234.3
    NL2011/12–2013/1431731.128.334.1
    Territories2008/09–2010/114739.230.448.5
    Territories2011/12–2013/144135.726.945.1

    + Expand Table

    Breast-conserving surgery data shown only include women who underwent breast-conserving surgery as a final procedure
    Territories include Yukon, Northwest Territories and Nunavut.
    Data source: Canadian Institute for Health Information, Hospital Morbidity Database, National Ambulatory Care Reporting System; Alberta Health and Wellness, Alberta Ambulatory Care Reporting System.

  • About this indicator

    About this indicator

    Key message

    The use of breast-conserving surgery appears to have increased in six provinces from 2008/09–2010/11 to 2011/12–2013/14.


    Indicator definition

    The percentage of women receiving a breast cancer resection for whom breast-conserving surgery (BCS) was their final procedure (i.e., where BCS was their first surgery or where a wider excision in the context of BCS was performed within one year of their first surgery). The data include women with unilateral invasive breast cancer whose surgery occurred between April 2008 and March 2014. Results are presented by province and year.


    Measured since

    The 2012 Cancer System Performance Report.


    Why measure this?

    Most women diagnosed with non-metastatic breast cancer are candidates for surgery, either mastectomy or breast-conserving surgery† followed by whole-breast radiation therapy (breast-conservation therapy).1 Breast-conservation therapy is less invasive than mastectomy and is associated with lower morbidity, improved cosmetic appearance and better psychological outcomes. In addition, mastectomy and breast-conservation therapy yield comparable survival outcomes.2-6 Since both procedures provide comparable outcomes, the choice between mastectomy and breast-conservation therapy should be made by the patient based on a clear understanding of the risks, benefits and quality of life considerations associated with each choice.


    What are the key findings?

    • The use of breast-conserving surgery ranged from 30.8% in Newfoundland and Labrador to 75.1% in Quebec (Figure 4.5).
    • The use of breast-conserving surgery appears to have increased in six provinces (British Columbia, Alberta, Ontario, Quebec, New Brunswick and Nova Scotia) from 2008/09–2010/11 to 2011/12–2013/14†† (Figure 4.6).

    Notes

    † Mastectomy is surgery to remove the entire breast. Breast-conserving surgery involves complete removal of the tumour along with a margin of non-cancerous breast tissue.

    †† The period 2008–10 refers to April 2008 to March 2011. The period 2011–14 refers to April 2011 to March 2014.


    Why do these findings matter?

    Across Canada, the use of breast-conserving surgery as a final procedure has increased in six provinces. This finding could indicate that more women are receiving breast-conserving surgery. Mastectomy and breast-conserving surgery followed by radiation therapy yield comparable survival outcomes.2-6 As such, the interprovincial differences shown here do not necessarily reflect differences in the quality of care. The choice between breast-conserving surgery followed by radiation therapy and mastectomy should be made by the patient based on a clear understanding of the benefits, risks and quality of life considerations associated with each treatment option.

    There is evidence that distance from a radiation treatment centre influences breast-conserving surgery rates. Patients who live far from the nearest radiation treatment centre may be less likely to undergo breast-conserving surgery due to the challenges of travelling post-operatively to a radiation treatment facility for several weeks of treatment. The choice of treatment may also be influenced by access to breast reconstruction, clinical factors (e.g., gene mutations that may predispose a woman to develop breast cancer, which can influence women to choose prophylactic removal of one or both breasts), surgeon preferences and training, and patient preferences.


    References

    1. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Breast Cancer Version 1.2016. 2015.
    2. Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011 Nov 12;378(9804):1707-16.
    3. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002 Oct 17;347(16):1227-32.
    4. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans V, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005 Dec 17;366(9503):2087-106.
    5. Arriagada R, Le MG, Rochard F, Contesso G. Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group. J Clin Oncol. 1996 May;14(5):1558-64.
    6. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002 Oct 17;347(16):1233-41.

     

  • Data specifications

    Data specifications

    Definition: The percentage of women receiving a breast cancer resection for whom breast-conserving surgery (BCS) was their final procedure (i.e., where BCS was their first surgery or where a wider excision in the context of BCS was performed within one year of their first surgery)

    Numerator: Women aged 18 and older who received breast conserving surgery (BCS) as their final procedure within one year

    Denominator: Women with unilateral invasive breast cancer who received breast conserving surgery and/or a mastectomy

    Data source: Hospital Morbidity Database, Canadian Institute for Health Information (CIHI); National Ambulatory Care Reporting System, CIHI; Alberta Ambulatory Care Reporting System, Alberta Health and Wellness

    Measurement timeframe: By province – 2009/10 to 2013/14 fiscal years combined. For trends – 2008/09–2010/11 and 2011/12–2013/14 fiscal years combined

    Stratification variables: Province/territory

    Provinces submitting data: BC, AB, SK, MB, ON, QC, NB, NS, PE, NL and Territories

    Notes:

    1. The following surgical and diagnostic codes, as documented in hospital patient records and reported to CIHI, were used to identify diagnoses and procedures per the following:
      1. In order to identify a breast cancer diagnosis, the following ICD-10-CA codes were used: C50.00, C50.01, C50.09, C50.10, C50.11, C50.19, C50.20, C50.21, C50.29, C50.30, C50.31, C50.39, C50.40, C50.41, C50.49, C50.50, C50.51, C50.59, C50.60, C50.61, C50.69, C50.80, C50.81, C50.89, C50.90, C50.91, C50.99. Women with unilateral invasive breast cancer were the focus of this analysis (comprising 98% of women with invasive breast cancer).
      2. In order to identify a mastectomy, the following surgical codes were used according to CCI: 1.YM.89 to 1.YM.92.
      3. The following CCI codes were used to identify a breast conserving surgery: 1.YM.87, 1.YM.88.
    2. Territories include YT, NT and NU.
    3. The data include women with unilateral invasive breast cancer.
    4. For comparison purposes, the same analysis was conducted looking at the use of mastectomies.
  • Related indicators

    Related Indicators

    Breast Cancer Mastectomies Done as Day Surgery

    Percentage of breast cancer mastectomies done as day surgery, by province/‌territory — 2008/09–2010/11 vs. 2011/12–2013/14 fiscal years combined
    View this indicator
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